Microbiota Gut-Brain Axis and Neurodegenerative Disease: A systematic review on Alzheimer’s disease, Amyotrophic lateral sclerosis and Parkinson Disease

This review highlights the microbiota gut-brain axis and neurodegenerative diseases excluding studies on animal models. Gut microbiota is capable of modulating some brain activities via the microbiota gut-brain axis. A bidirectional communication exists between the gastrointestinal (GI) tract and the central nervous system (CNS) in the microbiota gut-brain axis. Gut dysbiosis has been linked to neurodegenerative diseases as a result of the imbalance in the composition of its microbiota, which has a damaging effect on the host’s health. The association between the role and mechanism of CNS disease and gut microbial is yet to be fully explored. Although some studies have shown a positive relationship between a rich diverse microbial community and the brain of the host, and a negative relationship between microbial dysbiosis, intestinal infection and human brain health, our knowledge, however, is limited due to the inability to identify the major players in this heterogeneous microbial community

Comparison of the predictive strength of total white blood cell count within 24 hours on the outcome of traumatic brain injury with cranial computed tomography scan in a resource-limited tertiary health centre in sub-Saharan Africa

Background: The enormous disease burden of patients with traumatic brain injury (TBI) remains a huge source of concern to the patient and caregivers. Computed tomography (CCT) scan is a valuable investigative tool in patients with traumatic brain injury which can be used to predict the outcome of TBI. The use of total white blood cell as a predictive parameter in patients with TBI is still at a primordial stage. This study aimed to compare the predictive strength of total WBC count within 24 hours of TBI with cranial computed tomography scan. Methods: This research was done over one-year period at the Lagos University Teaching Hospital, Lagos. One hundred and fifty-eight patient who met the inclusion criteria were studied and the male to female ratio of 3.6:1. Results: The mean total WBC count was 14,279.94 and the area under the curve of total WBC count and CCT scan was 0.633 and 0.855 respectively. Conclusion: Our conclusion was that despite both parameters been a predictor of the outcome of TBI, the total white blood cell is a weaker predictor of outcome compared to cranial computerize tomography scan

Defect in Synaptic Pruning of Motor Cortex Neurons is Associated with Early Perturbed Dopaminergic System

Background: Early stress exposure during neurodevelopmental stages has been linked to some adult neuropsychiatric disorders. The dopaminergic system which has been implicated in movement and reward system has been linked to movement and mood disorders when perturbed at early development. This study is designed to check the mechanisms involved in movement disorders such as dyskinesia, associated with early perturbed dopaminergic system in the motor cortex. Methods:Haloperidol was used to block D2R in neonatal albino Wistar rats in utero by administering 20 mg/kg BW (intraperitoneally) to pregnant adult wistar rats (n=8) in the third week of gestation. Behavioural studies such as the rotarod test were carried out on the neonatal animals (n=5) to test their motor function at postnatal day twentyeight (P28). Electrophysiological recordings were carried out on the motor cortex (M1) to determine the significance of D2R inhibition on calcium neural activity. Immunofluorescence was done to demonstrate synaptic vesicle protein (SV) and microtubule associated protein kinases (MAP K) as a measure of synapses count and microtubule phosphorylation respectively. Results: Behavioural studies showed a decline in motor function of animals exposed to haloperidol in utero compared to the control. This motor deficit was accompanied by a significant increase in the Ca 2+ neural activity of the motor cortex as shown by electrophysiological recordings. Immunofluorescence staining showed there was significant increase in the number of MAPK+ and SV+ cells in the motor cortex of haloperidol exposed animals compared to the control. Conclusion: These findings showed that early perturbation in dopaminergic system is associated with an increase in synapses and neuronal density, as well as an increase in phosphorylation of microtubules of neurons in the motor cortex

Tobacco related knowledge and support for smoke-free policies among community pharmacists in Lagos state, Nigeria

Background: There are no safe levels of exposure to second hand smoke and smoke-free policies are effective in reducing the burden of tobacco-related diseases and death. Pharmacists, as a unique group of health professionals, might be able to play a role in the promotion of smoke-free policies.Objective: To determine the tobacco-related knowledge of community pharmacists and assess their support for smoke-free policies in Lagos state, Nigeria.Methods: A cross-sectional descriptive study design using both quantitative and qualitative methods was employed. Two hundred and twelve randomly selected community pharmacists were surveyed using a pre-tested self-administered questionnaire. In addition, one focus group discussion was conducted with ten members of the Lagos state branch of the Association of Community Pharmacists of Nigeria.Results: The quantitative survey revealed that the majority (72.1%) of the respondents were aged between 20 and 40 years, predominantly male (60.8%), Yoruba (50.2%) or Igbo (40.3%) ethnicity and had been practicing pharmacy for ten years or less (72.2%). A majority (90.1%) of respondents were aware that tobacco is harmful to health. Slightly less (75.8%) were aware that second hand smoke is harmful to health. Among the listed diseases, pharmacists responded that lung (84.4%) and esophageal (68.9%) cancers were the most common diseases associated with tobacco use. Less than half of those surveyed associated tobacco use with heart disease (46.9%), chronic obstructive pulmonary disease (27.8%), bladder cancer (47.2%), peripheral vascular disease (35.8%) and sudden death (31.1%). Only 51.9% had heard of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). A little over half of the respondents (53.8%) were aware of any law in Nigeria controlling tobacco use. The majority of respondents supported a ban on smoking in homes (83.5%), in public places (79.2%), and in restaurants, nightclubs and bars (73.6%). For every additional client attended to daily, knowledge scores increased by 0.022 points. Current smokers were 1.3 times less likely to support smoke-free policies compared with non-smokers. The findings emanating from the focus group discussion reinforced the fact that the pharmacists were in support of smoke-free policies particularly in homes and public places. It also demonstrated that most of them were aware of the health risks associated with tobacco use and second hand smoke however some misconceptions seemed to exist.Conclusion: The pharmacists surveyed expressed support of smoke-free policies and most of them were aware of the health risks associated with tobacco use. However, awareness of WHO FCTC and country-level tobacco legislation was low. Current smokers were less likely to support smoke-free policies. Community pharmacists should therefore be considered worth engaging for the promotion of smoke-free policies. Efforts should also be made to educate pharmacists about country level smoke-free laws

Management and Prevention of Surgical Site Infections in Spine Surgery in a Resource Poor Setting: The Irrua Protocol

Background and Aim: Surgical site infections (SSIs) in spine surgeries represent one of the most common hospital-acquired infections. SSI (refers to surgical wound infection within 30 days of surgery or 1 year after implant) portends a huge disease burden with devastating consequences for the patient and the hospital facilities with physical and psychological trauma to the patient and it is associated with an increased rate of morbidity and mortality. Despite improvements in the surgical protocol for asepsis and the role of prophylactic antibiotics in clean spine surgeries, a substantial increase still exists in the rate of SSIs. It is essential to review and identify factors predisposing patients with spinal problems to SSIs and its goal is to formulate a local protocol that helps to curtail SSIs and can be replicated in any setting in the world, considering the limitations of our setting. This study aims to review the risk factors for SSI following spine surgeries considering a 54-year-old woman with obesity who had SSI and highlights prevention ways. Methods and Materials/Patients: This study includes the search of the literature using several platforms, such as Google Scholar, Hinari, PubMed, Academia, and other search engines with related keywords to surgical site infections in spine surgery. The retrieved articles were reviewed and in some parts, the narrative case of the 54-year-old obese woman was discussed in the literature. Results: A total of 37 articles were found that matched the search words and satisfied the objective of the study. These articles were reviewed and used in writing this manuscript. Conclusion: SSIs are on the increase, and identifying risk factors on a patient basis is key to prevention. Protocol on preventive measures should be strictly followed to avoid catastrophes associated with SSIs

Comparison of the Predictive Strength of Total White Blood Cell Count Within 24 Hours on Outcome of Traumatic Brain Injury with Glasgow Coma Score and Pupillary Reactivity

Background: Clinical parameters such as Glasgow coma score (GCS) and pupillary reactivity (PR) have been identified as useful indicators for predicting traumatic brain injury (TBI). Total white blood cell (WBC) count is a laboratory test whose role in predicting TBI is still at low ebb. It is known to be elevated due to varied reasons in traumatic brain injury and this has been found to correlate with poor outcome. Our study aimed to establish if the predictive strength of total WBC count can be compared with other known outcome models (GCS score and PR). Methodology: This research was done as a hospital based prospective study of 158 patients who presented with isolated TBI within 24 hours of injury over a one-year period from October 2014-September 2015. Total white blood cell count was assayed within 24 hours of injury and clinical parameters – GCS and PR were assessed within 24 hours of same injury. Data analysis was done using statistical package for social science (SPSS) Illinois Chicago version 21. The P value of <0.05 was taken as significant. Results: In this study the predictive value of total WBC was weak, evident by area under the curve of 0.633 compared to that of total WBC count and PR , which was statistically significant at p<0.001 Conclusion: The predictive strength of total white cell count in patients with traumatic brain injury is weaker compared to clinical tool (PR and GCS) used to predict outcome in TBI.Keywords: Brain trauma, Clinical parameters, Laboratory test, Glasgow Coma Scal

Pharmacist-led smoking cessation: The attitudes and practices of community pharmacists in Lagos state, Nigeria: A mixed methods survey

Introduction Community pharmacists are well-positioned to support smoking cessation particularly in low and middle income countries. This study aims to assess the attitudes, barriers and pattern of pharmacist-led smoking cessation services and explore the factors associated with the willingness to offer smoking cessation services. Methods A cross-sectional descriptive study was carried out using qualitative and quantitative methods. Two hundred and forty two community pharmaceutical premises were randomly selected and interviewed. In addition, one Focus Group Discussion was carried out among nine members of the state branch of the Association of Community Pharmacists of Nigeria in Lagos state. Results Approximately 92% had ever encountered smokers in the course of their work however only 49.6% had ever inquired of their smoking status and 49.1% had offered some form of cessation support. Only 44% had NRT’s available within their pharmaceutical premises. Majority (68.5%) were willing to offer smoking cessation services in their premises however only 44.6% had ever received any prior training on tobacco cessation. Those who believed that pharmacists had the required training to offer smoking cessation services were more willing to provide these services. Qualitative findings also revealed that majority felt they had a unique role to play in providing tobacco cessation services. Conclusions These pharmacists were willing to provide smoking cessation services within their practice, however they may require specific training to do so effectively. In developing guidelines for community based smoking cessation, it is recommended that pharmacists be engaged and trained for the provision of smoking cessation services within the community